Department of Psychiatry.
Department of Psychiatry and Psychology.
Psychol Trauma. 2020 Nov;12(8):821-824. doi: 10.1037/tra0000994.
The popularity of complementary and integrative health (also complementary integrated health; CIH) approaches has significantly increased in recent years. According to the National Center for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health, about 1 in 3 adults and 1 in 9 children used CIH approaches to healing. Some reports estimate that the use of CIH approaches will continue to increase (Clarke et al., 2015) as these therapies are cost effective and also due to the difficulties in finding trained mental health professionals (Simon et al., 2020). For the purpose of this special issue, we use the NCCIH's definition of CIH as "a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine" (Barnes et al., 2004, p. v). However, the integration of these therapies into the health system has not followed the same pattern despite the fact that patients report the need to discuss CIH therapies with their doctors or are actually using them (de Jonge et al., 2018; Jou & Johnson, 2016; Stapleton et al., 2015). This inability to keep up with the demand or patients' preference is possibly due to providers' lack of understanding and/or knowledge of these therapies, as well as scientific skepticism (Ali & Katz, 2015; Fletcher et al., 2017). Using data from the 2012 National Health Interview Survey, Jou & Johnson (2016) identified patterns of CIH use in the United States and reasons for patients' nondisclosure of the use of these therapies. Patients' fear of disclosure due to perceived skepticism or disapproval from their provider was frequently attributed as a cause of patients' nondisclosures to providers about the use of these therapies (Eisenberg et al., 2001; Jou & Johnson, 2016; Thomson et al., 2012). The arrival of patient-centered care models is beginning to shift the ways we understand the patient's role in treatment engagement. Patient-centered approaches often emphasize the use of preventative and holistic wellness models that go beyond the use of evidence-based treatments. This approach also seeks to be culturally responsive, which is a key factor in addressing health disparities in the United States (American Psychological Association [APA], 2019). The Institute of Medicine, in its report on CIH therapies, highlighted the importance of engaging patients in their own care, including having a decision about therapeutic options (Bondurant et al., 2005). Likewise, the Race and Ethnicity Guidelines in Psychology (APA, 2019) recommend psychologists engage the patient's cultural beliefs, or what Kleinman called the "explanatory belief model" (Kleinman, 1978)- for example, by "aim[ing] to understand and encourage indigenous/ ethnocultural sources of healing within professional practice" (APA, 2019, p. 24). (PsycInfo Database Record (c) 2020 APA, all rights reserved).
近年来,补充和整合健康(也称为补充综合健康;CIH)方法的普及显著增加。根据美国国立卫生研究院下属的国家补充与综合健康中心(NCCIH)的数据,约有 1/3 的成年人和 1/9 的儿童使用 CIH 方法进行治疗。一些报告估计,随着这些疗法具有成本效益,而且也因为难以找到训练有素的心理健康专业人员(Simon 等人,2020),CIH 方法的使用将继续增加。出于本期特刊的目的,我们使用 NCCIH 将 CIH 定义为“一组不同的医学和保健系统、实践和产品,目前不被认为是常规医学的一部分”(Barnes 等人,2004 年,第 v 页)。然而,尽管患者报告需要与医生讨论 CIH 疗法,或者实际上正在使用这些疗法,但这些疗法在卫生系统中的整合并没有遵循相同的模式(de Jonge 等人,2018 年;Jou 和 Johnson,2016 年;Stapleton 等人,2015 年)。这种无法满足需求或患者偏好的情况可能是由于提供者对这些疗法缺乏理解和/或了解,以及对科学的怀疑(Ali 和 Katz,2015 年;Fletcher 等人,2017 年)。使用 2012 年全国健康访谈调查的数据,Jou 和 Johnson(2016 年)确定了美国 CIH 使用的模式以及患者不披露这些疗法使用情况的原因。患者由于担心提供者的怀疑或不赞成而不愿披露的情况经常被归因于患者不向提供者披露这些疗法的使用情况的原因(Eisenberg 等人,2001 年;Jou 和 Johnson,2016 年;Thomson 等人,2012 年)。以患者为中心的护理模式的出现开始改变我们对患者在治疗参与中的角色的理解方式。以患者为中心的方法通常强调使用预防和整体健康模型,而不仅仅是基于证据的治疗方法。这种方法还力求具有文化响应性,这是解决美国健康差异的关键因素(美国心理学会 [APA],2019 年)。医学研究所(IOM)在其关于 CIH 疗法的报告中强调了让患者参与自己的治疗的重要性,包括对治疗选择做出决定(Bondurant 等人,2005 年)。同样,心理学中的种族和民族准则(APA,2019 年)建议心理学家参与患者的文化信仰,或者 Kleinman 所说的“解释性信仰模型”(Kleinman,1978 年)-例如,“旨在理解和鼓励专业实践中的本土/民族文化疗愈来源”(APA,2019 年,第 24 页)。(PsycInfo 数据库记录(c)2020 APA,保留所有权利)。